[RNKittyKat]

I'm a new RN, and new on a neuro trauma ICU. It is very important that I understand assessment descriptions. My last pt. was an SAH/SDH whose only response was localization to deep (and I mean deep) painful stimuli. No spontaneous movement and follows commands x0. 8 on the GCS. I described her in my assessment as "obtunded". My preceptor corrected me and pointed out that she was "lethargic". Lethargic in my mind describes someone who is drowsy but arousable. I think I can describe myself as lethargic at times. Can you experienced nurses shed some light on this assessment paramater so that I might better understand? Would love some insight on this.

[gwenith]

I have only ever seen the descriptors used in a handful of books - they have long been replaced with the Glascow Coma Scale simply because they were too confusing.

Dictonary definition

Obtunded: Mentally dulled. A person may be obtunded due to head trauma. To obtund is to dull or blunt. From the Latin obtundere, to blunt.

http://www.medterms.com/script/main/...rticlekey=4614

An alert patient is vigilantly attentive and keen. A lethargic patient is dull, sluggish and appears half asleep. An obtunded patient opens their eyes, responds slowly to questions, is somewhat confused, and has a decreased interest in their environment. A stuporous patient is near unconscious with apparent mental inactivity and reduced ability to respond to stimulation. Comatose patients are unconscious and unresponsive.

http://endeavor.med.nyu.edu/neurosur...inimental.html

[suzanne4]

I do not agree with your preceptor. Any time that you really need to physically stimulate a patient to get any type of respnse from them, that is obtunded. If you did nothing, they would be doing nothing.

Lethargic is someone who is very sleepy, but arouses easily by name calling or just a slight tap, but true physical stimulation needed and that is obtunded.

[EricEnfermero]

I think everyone has slightly different ideas on what those descriptors mean. While I would agree with you, it's probably better to stick to more objective stuff, like GCS as Gwenith suggests. If you tell us that the pt withdraws an extremity with painful stimuli, then we're all pretty much on the same page.

[RNKittyKat]

Thanks for the replies and advice. I did as was suggested on my shift yesterday. When charting, I avoided the whole word descriptor altogether and stuck with more objective information. So much to learn!

[valene]

The terminology goes like this (in this order of progression) confusion=> lethargy=> obtunded=> stupor=> coma

[dorimar]

Gesparis says it's better to be obtunded then sturporous. Obtunded, you are very difficult to arouse, but when you do arouse you talk clearly (even if only for 10 secs) and then you're out again. Stuporous you are very difficult to arouse and when you are aroused it is slurred garbled nonsense then you are out again. At least that's what I got from her CCRN tapes. (Lethargy is just mildl diffiuclty to arouse, like really drowsy).

[leggendario]

What do you mean by the abbreviation SAH/SDH

[valene]

SAH=subarachnoid hemorrhage
SDH=subdural hemorrhage

[leggendario]

Thanks for the reply,
As for the new definition by the word obtuned. I think being in an obtuned state it is more likely similar to being in a state of drowsiness. What do you think guys ???